Rethinking primary care’s gatekeeper role

  title={Rethinking primary care’s gatekeeper role},
  author={Geva Greenfield and Kimberley A Foley and Azeem Majeed},
  journal={British Medical Journal},
Geva Greenfield and colleagues ask whether it is time to reconsider the role of the GP as gatekeeper to specialist services, and call for more evidence to guide future policy 
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Examining primary care’s gatekeeping role covers only one aspect of primary care; excluding other, more important, elements risks these being forgotten entirely.
Tension in the primary–secondary care interface: changing medical students’ views on general practice
As the first point of contact for 90% of National Health Service patients, general practitioners (GPs) are important gatekeepers of health care. Yet, in the context of our educational experiences,
Stop calling GPs gatekeepers
Am I alone in regarding the description of my job as a gatekeeper to be inaccurate, condescending, and demeaning?1 Gatekeepers prevent admission. Like the sinister gatekeeper in Kafka’s parable
General practitioner as a gatekeeper and medical scheme benefit design in South Africa.
A shift in benefit design was revealed and that medical scheme members bypass GPs directly to specialist services which is a secondary level of care, thus undermining the role of GPs as gatekeepers.
Shared decision making between patient and GP about referrals from primary care: Does gatekeeping make a difference?
The findings imply that GPs in gatekeeper systems seem to be less inclined to Shared decision-making thanGPs in a non-gatekeeping system, and a more contextualized approach is needed to understand the relation between gatekeeping as a system design feature and its relation with and/or impact on SDM.
Exploring general practitioners’ perceptions about the primary care gatekeeper role in Indonesia
GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care, however, their attitudes towards the gatekeeper function are less positive.
Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review.
Gatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction, and the long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.
Strategies to strengthen referral from primary care to secondary care in low- and middle-income countries
Strategies to strengthen referral from primary care to secondary care in lowand middle-income countries and the decision-makers who shape policy and practice are studied.
What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance
Concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation, which had an impact on how the PCPs utilised MAW services.


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  • N. Hawkes
  • Medicine
    BMJ : British Medical Journal
  • 2014
How can people who need specialist care get it more quickly?
Self referral to physiotherapy and other services would empower patients and doctors
The authors should make direct access easy when the benefits outweigh the risks, and not just when the risks outweigh the benefits.
Australian Health Care--The Challenge of Reform in a Fragmented System.
  • Jane Hall
  • Political Science, Medicine
    The New England journal of medicine
  • 2015
Australia has tried numerous approaches to health care financing in recent decades, and its health care system now relies on a complex set of overlapping and fragmented responsibilities. Yet
Primary care gatekeeping and referrals: effective filter or failed experiment?
  • C. Forrest
  • Medicine, Political Science
    BMJ : British Medical Journal
  • 2003
The concept of gatekeeping is discussed, the processes of referral to specialists in the United States and the United Kingdom are contrasted, the mechanisms by which gatekeeping influences resource allocation are examined, and the effects of linking gatekeeping with financial incentives and utilisation review are discussed.
Gatekeeping in Health Care
Primary Care in England: Between a Rock and a Hard Place
  • A. Majeed
  • Political Science, Medicine
    The Journal of ambulatory care management
  • 2013
A well-established primary care sector has allowed England's National Health Service (NHS) to make efficient use of resources through the gatekeeping role that general practitioners have in
Competition, gatekeeping, and health care access.
Gatekeeping and provider choice in OECD healthcare systems
An extended review of evidence on the impact of gatekeeping and provider choice on efficiency, costs, quality, equality and patient empowerment is provided and a trend towards strengthening gatekeeping regulations within free access countries is discovered.
Unlocking specialists' attitudes toward primary care gatekeepers.
Specialists' attitudes toward the coordinating role of primary care physicians are influenced by the practice setting in which the specialists work and by financial interests that may be threatened by referral restrictions.
Is gatekeeping better than traditional care? A survey of physicians' attitudes.
Positive ratings of gatekeeping were associated with fewer years in clinical practice, generalist training, and experience with gatekeeping and health maintenance organization plans, and both positive and negative effects of Gatekeeping were identified.